WTC exterior inspection form for 112-114 Chambers Street

NYC 9/11 Public Portal Document

E.P.A. AGENCY #99 49024 CT, MA, RI, VT, NH, ME NY GENERATORS WASTE MANAGEMENT GENERATORS EPA Region 2 LOG'ANO EPA New England 1 Congress Street 290 Broadway, 26th Floor New York, NY 10007-1866 EMERGENCY RESPONSE O. &,x 144 • Portland, CT .6480 TELEPHONE (860) 342-0667 • tax: (860) 342-4866 Boston, MA 02114-2023 (212) 264-6770 Out of State 1-800-272-3867 (617) 918-1111 #1-800-272-3867

FB# ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number P.O. # GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. SI JIE MIE INC Address 114 CHAMBERS STREET Address 3010 BURNS AVENUE city City WANTAGH State NY Zip 11793 NEW i 8? K, NY 100&p 781_000 Phone Number Telephone Number (5 Date Container Del. Date of Pickup GENERATING LOCATION

Type of Container 100 YARD Address VOLUME 114 CY Friable Jg( Non-Friable ❑ City State Zio Bags Drum ❑ Wrapped ❑ Other ❑ NEW YORK. NY 10001 Phone Number RQ, ASBESTOS, 9, NA2212, PG III INV t F1040 I certify the above named material does not contain free liquid as defined by 40 CFR part 260.10 or any applicable state law, is not a hazardous waste as defined by 40 CFR part 261 or any applicable state law, has been properly described, classified and packaged, and is in proper condition for transportation according to NESHAP standards for asbestos waste disposal found in 40 CFR part 61.150. Shipper's Certification: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national government regulations. \ , AUTHORIZED SIGNA Transporter 1: Address Telephone # Driver: t Name ( ~~ é- Signature Registration #: NY 480 139 AR State / # Date: 07124)2 Acknowledgement of receipt of materials.

Transporter 2: Waste Mana E.E.T. Inc. PO Box 144, Portland, CT 06480 1-800-272-3867

Driver: Registration #: ~ ~~ Date: ig lure State Acknowledgement of receipt of materials.

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING'STREET • PORTLAND, CT 06480 PHONE: (800) 272-3867 PERMIT # SW 1130223 Received By: Date: Certification of receipt of materials covered by this manifest.

Transporter 3:

Driver: Name

Signature \A_Registration Address #: State / # Date: Telephone #

owle ment of receipt of materials.

Landfill Name Phone No: Location: Permit Approximate Volume of Asbestos Received: \/i. _ Discrepancy If Any: Received by: 4~~~ Date: _L _ __' " Certification of receipt of materials covered by this manifest.

COPY 1 - GENERATOR NYC-WTC 000121856